Provider Demographics
NPI:1609473255
Name:KAMARA, JACOB
Entity Type:Individual
Prefix:
First Name:JACOB
Middle Name:
Last Name:KAMARA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13917 CASTLE BLVD
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20904-4917
Mailing Address - Country:US
Mailing Address - Phone:240-422-7660
Mailing Address - Fax:
Practice Address - Street 1:13917 CASTLE BLVD
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20904-4917
Practice Address - Country:US
Practice Address - Phone:240-422-7660
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-07
Last Update Date:2020-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDA00155879Medicaid